Skip to main content
SpringerLink
Log in

Skeletally Mature Acetabular Dysplasia: Epidemiology, Natural History, Clinical Presentation, Imaging Studies, Non-Operative Treatment, Operative Treatment

  • Reference work entry
  • First Online:
Hip Arthroscopy and Hip Joint Preservation Surgery

  • 2966 Accesses

Abstract

Skeletally mature acetabular dysplasia (SMAD) is a recognized cause of hip pain in active young adults. The majority of hip dysplasia is treated in childhood by improving the physiologic and anatomic environment of the hip allowing it to develop into a morphologically sound structure. The abnormal morphology of the mature dysplastic hip can be subtle both clinically and radiographically which can often lead to a delay in diagnosis.

The goal of treatment with SMAD is first and foremost to recognize the specific pathology causing the common complaints of hip pain. Hip pain, limp, and mechanical symptoms that can present with SMAD may be the same presenting complaints in patients with either femoroacetabular impingement (FAI) or mild osteoarthritis (OA). Plain radiographs and MRI provide the diagnosis, which in turn allows the treating physician to choose the appropriate treatment course.

Treatment of SMAD generally falls into one of two categories. For patients who present without radiographic signs of OA, the goal is to preserve the native cartilage of the hip by creating a more mechanically sound hip. The periacetabular osteotomy (PAO) reorients the acetabulum, providing stability to the hip and decreasing cartilage stress. Patients who present with moderate to severe OA generally do not obtain good results with hip preservation procedures and, therefore, may require total hip arthroplasty to address their hip pain. Although results are excellent with total joint replacement, the mainstay of treatment for SMAD should be recognition via clinical and radiographic examination followed by prompt treatment, if indicated, to help preserve the native hip joint.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 599.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 799.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Crawford MJ, Dy CJ, Alexander JW, Thompson M, Schroder SJ, Vega CE, et al. The 2007 Frank Stinchfield award. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16–22.

    PubMed  Google Scholar 

  2. Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36(2):171–8.

    Article  CAS  PubMed  Google Scholar 

  3. McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The watershed labral lesion: its relationship to early arthritis of the hip. J Arthroplasty. 2001;16(8 Suppl 1):81–7.

    Article  CAS  PubMed  Google Scholar 

  4. Li PL, Ganz R. Morphologic features of congenital acetabular dysplasia: one in six is retroverted. Clin Orthop Relat Res. 2003;416:245–53.

    Article  PubMed  Google Scholar 

  5. Mast JW, Brunner RL, Zebrack J. Recognizing acetabular version in the radiographic presentation of hip dysplasia. Clin Orthop Relat Res. 2004;418:48–53.

    Article  PubMed  Google Scholar 

  6. MacKenzie JR, Kelley SS, Johnston RC. Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip. Long-term results. J Bone Joint Surg Am. 1996;78(1):55–61.

    CAS  PubMed  Google Scholar 

  7. Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Joint Surg Am. 1995;77(7):985–9.

    CAS  PubMed  Google Scholar 

  8. Jessel RH, Zurakowski D, Zilkens C, Burstein D, Gray ML, Kim YJ. Radiographic and patient factors associated with pre-radiographic osteoarthritis in hip dysplasia. J Bone Joint Surg Am. 2009;91(5):1120–9.

    Article  PubMed  Google Scholar 

  9. Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466(2):264–72.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br. 1991;73(3):423–9.

    CAS  PubMed  Google Scholar 

  11. Hashimoto S, Rai MF, Gill CS, Zhang Z, Sandell LJ, Clohisy JC. Molecular characterization of articular cartilage from young adults with femoroacetabular impingement. J Bone Joint Surg Am. 2013;95(16):1457–64.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Troelsen A. Assessment of adult hip dysplasia and the outcome of surgical treatment. Dan Med J. 2012;59(6):B4450.

    PubMed  Google Scholar 

  13. Peled E, Eidelman M, Katzman A, Bialik V. Neonatal incidence of hip dysplasia: ten years of experience. Clin Orthop Relat Res. 2008;466(4):771–5.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Howorth B. “Congenital dislocation” of the hip … its early diagnosis and treatment. Arch Pediatr. 1962;79:1–17.

    CAS  PubMed  Google Scholar 

  15. Lee CB, Mata-Fink A, Millis MB, Kim YJ. Demographic differences in adolescent-diagnosed and adult-diagnosed acetabular dysplasia compared with infantile developmental dysplasia of the hip. J Pediatr Orthop. 2013;33(2):107–11.

    Article  PubMed  Google Scholar 

  16. Gosvig KK, Jacobsen S, Sonne-Holm S, Palm H, Troelsen A. Prevalence of malformations of the hip joint and their relationship to sex, groin pain, and risk of osteoarthritis: a population-based survey. J Bone Joint Surg Am. 2010;92(5):1162–9.

    Article  PubMed  Google Scholar 

  17. Sankar WN, Nevitt M, Parvizi J, Felson DT, Agricola R, Leunig M. Femoroacetabular impingement: defining the condition and its role in the pathophysiology of osteoarthritis. J Am Acad Orthop Surg. 2013;21 Suppl 1:S7–15.

    Article  PubMed  Google Scholar 

  18. Nunley RM, Prather H, Hunt D, Schoenecker PL, Clohisy JC. Clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients. J Bone Joint Surg Am. 2011;93 Suppl 2:17–21.

    Article  PubMed  Google Scholar 

  19. Wall PD, Fernandez M, Griffin DR, Foster NE. Nonoperative treatment for femoroacetabular impingement: a systematic review of the literature. PM & R J Inj Funct Rehabil. 2013;5(5):418–26.

    Article  Google Scholar 

  20. Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. 2009;467(3):638–44.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Shu B, Safran MR. Hip instability: anatomic and clinical considerations of traumatic and atraumatic instability. Clin Sports Med. 2011;30(2):349–67.

    Article  PubMed  Google Scholar 

  22. Troelsen A, Mechlenburg I, Gelineck J, Bolvig L, Jacobsen S, Soballe K. What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics? Acta Orthop. 2009;80(3):314–8.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Clohisy JC, Carlisle JC, Beaule PE, Kim YJ, Trousdale RT, Sierra RJ, et al. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90 Suppl 4:47–66.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Tannast M, Zheng G, Anderegg C, Burckhardt K, Langlotz F, Ganz R, et al. Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res. 2005;438:182–90.

    Article  CAS  PubMed  Google Scholar 

  25. Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic tilt on acetabular retroversion: a study of pelvis from cadavers. Clin Orthop Relat Res. 2003;407:241–8.

    Article  PubMed  Google Scholar 

  26. Troelsen A, Jacobsen S, Romer L, Soballe K. Weightbearing anteroposterior pelvic radiographs are recommended in DDH assessment. Clin Orthop Relat Res. 2008;466(4):813–9.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Nepple JJ, Prather H, Trousdale RT, Clohisy JC, Beaule PE, Glyn-Jones S, et al. Clinical diagnosis of femoroacetabular impingement. J Am Acad Orthop Surg. 2013;21 Suppl 1:S16–9.

    Article  PubMed  Google Scholar 

  28. Troelsen A, Romer L, Kring S, Elmengaard B, Soballe K. Assessment of hip dysplasia and osteoarthritis: variability of different methods. Acta Radiol. 2010;51(2):187–93.

    Article  PubMed  Google Scholar 

  29. Troelsen A, Elmengaard B, Soballe K. Medium-term outcome of periacetabular osteotomy and predictors of conversion to total hip replacement. J Bone Joint Surg Am. 2009;91(9):2169–79.

    Article  PubMed  Google Scholar 

  30. Hartig-Andreasen C, Troelsen A, Thillemann TM, Soballe K. What factors predict failure 4 to 12 years after periacetabular osteotomy? Clin Orthop Relat Res. 2012;470(11):2978–87.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL. Medial translation of the hip joint center associated with the Bernese periacetabular osteotomy. Iowa Orthop J. 2004;24:43–8.

    PubMed Central  PubMed  Google Scholar 

  32. Fujii M, Nakashima Y, Yamamoto T, Mawatari T, Motomura G, Matsushita A, et al. Acetabular retroversion in developmental dysplasia of the hip. J Bone Joint Surg Am. 2010;92(4):895–903.

    Article  PubMed  Google Scholar 

  33. Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br. 1999;81(2):281–8.

    Article  CAS  PubMed  Google Scholar 

  34. Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clin Orthop Relat Res. 2008;466(3):677–83.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Peters CL, Erickson JA, Hines JL. Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg Am. 2006;88(9):1920–6.

    Article  PubMed  Google Scholar 

  36. Meyer DC, Beck M, Ellis T, Ganz R, Leunig M. Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res. 2006;445:181–5.

    PubMed  Google Scholar 

  37. Lequesne M, Djian A. New radiographic angles for the study of the hip. The “false profile” of the pelvis. Vie Med. 1961;42:1629–41.

    CAS  PubMed  Google Scholar 

  38. Sakai T, Nishii T, Sugamoto K, Yoshikawa H, Sugano N. Is vertical-center-anterior angle equivalent to anterior coverage of the hip? Clin Orthop Relat Res. 2009;467(11):2865–71.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Troelsen A, Romer L, Jacobsen S, Ladelund S, Soballe K. Cranial acetabular retroversion is common in developmental dysplasia of the hip as assessed by the weight bearing position. Acta Orthop. 2010;81(4):436–41.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Leunig M, Podeszwa D, Beck M, Werlen S, Ganz R. Magnetic resonance arthrography of labral disorders in hips with dysplasia and impingement. Clin Orthop Relat Res. 2004;418:74–80.

    Article  PubMed  Google Scholar 

  41. Toomayan GA, Holman WR, Major NM, Kozlowicz SM, Vail TP. Sensitivity of MR arthrography in the evaluation of acetabular labral tears. AJR Am J Roentgenol. 2006;186(2):449–53.

    Article  PubMed  Google Scholar 

  42. Freedman BA, Potter BK, Dinauer PA, Giuliani JR, Kuklo TR, Murphy KP. Prognostic value of magnetic resonance arthrography for Czerny stage II and III acetabular labral tears. Arthroscopy. 2006;22(7):742–7.

    Article  PubMed  Google Scholar 

  43. Keeney JA, Peelle MW, Jackson J, Rubin D, Maloney WJ, Clohisy JC. Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology. Clin Orthop Relat Res. 2004;429:163–9.

    Article  PubMed  Google Scholar 

  44. Cunningham T, Jessel R, Zurakowski D, Millis MB, Kim YJ. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage to predict early failure of Bernese periacetabular osteotomy for hip dysplasia. J Bone Joint Surg Am. 2006;88(7):1540–8.

    Article  PubMed  Google Scholar 

  45. Babst D, Steppacher SD, Ganz R, Siebenrock KA, Tannast M. The iliocapsularis muscle: an important stabilizer in the dysplastic hip. Clin Orthop Relat Res. 2011;469(6):1728–34.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  46. Troelsen A, Jacobsen S, Bolvig L, Gelineck J, Romer L, Soballe K. Ultrasound versus magnetic resonance arthrography in acetabular labral tear diagnostics: a prospective comparison in 20 dysplastic hips. Acta Radiol. 2007;48(9):1004–10.

    Article  CAS  PubMed  Google Scholar 

  47. Hunt D, Prather H, Harris Hayes M, Clohisy JC. Clinical outcomes analysis of conservative and surgical treatment of patients with clinical indications of prearthritic, intra-articular hip disorders. PM & R J Inj Funct Rehabil. 2012;4(7):479–87.

    Article  Google Scholar 

  48. Lewis CL, Sahrmann SA. Acetabular labral tears. Phys Ther. 2006;86(1):110–21.

    PubMed  Google Scholar 

  49. Byrd JW, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med. 2004;32(7):1668–74.

    Article  PubMed  Google Scholar 

  50. Pateder DB, Hungerford MW. Use of fluoroscopically guided intra-articular hip injection in differentiating the pain source in concomitant hip and lumbar spine arthritis. Am J Orthop (Belle Mead NJ). 2007;36(11):591–3.

    Google Scholar 

  51. Bogunovic L, Gottlieb M, Pashos G, Baca G, Clohisy JC. Why do hip arthroscopy procedures fail? Clin Orthop Relat Res. 2013;471(8):2523–9.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Clohisy JC, Beaule PE, O’Malley A, Safran MR, Schoenecker P. AOA symposium. Hip disease in the young adult: current concepts of etiology and surgical treatment. J Bone Joint Surg Am. 2008;90(10):2267–81.

    Article  PubMed  Google Scholar 

  53. Schoenecker PL, Clohisy JC, Millis MB, Wenger DR. Surgical management of the problematic hip in adolescent and young adult patients. J Am Acad Orthop Surg. 2011;19(5):275–86.

    PubMed  Google Scholar 

  54. Numair J, Joshi AB, Murphy JC, Porter ML, Hardinge K. Total hip arthroplasty for congenital dysplasia or dislocation of the hip. Survivorship analysis and long-term results. J Bone Joint Surg Am. 1997;79(9):1352–60.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Galter Pavilion, 675 North St Clair, Suite: 17-100, 60611, Chicago, IL, USA

    Anay Patel, John P. Manalo & Michael D. Stover

Authors
  1. Anay Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John P. Manalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael D. Stover
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael D. Stover .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Shane J. Nho

  2. Department of Orthopaedic Surgery, Schulthess Klinik, Zurich, Switzerland

    Michael Leunig

  3. Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics - Edina, Edina, Minnesota, USA

    Christopher M. Larson

  4. Department of Orthopaedics, University of Michigan, Ann Arbor, Michigan, USA

    Asheesh Bedi

  5. Sports Medicine and Shoulder Service and Center for Hip Preservation Surgery, Hospital for Special Surgery, New York, New York, USA

    Bryan T. Kelly

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this entry

Cite this entry

Patel, A., Manalo, J.P., Stover, M.D. (2015). Skeletally Mature Acetabular Dysplasia: Epidemiology, Natural History, Clinical Presentation, Imaging Studies, Non-Operative Treatment, Operative Treatment. In: Nho, S., Leunig, M., Larson, C., Bedi, A., Kelly, B. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6965-0_47

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6965-0_47

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6964-3

  • Online ISBN: 978-1-4614-6965-0

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation